Diabetes mellitus is essentially a problem with keeping your blood sugar in check, and this can have far-reaching consequences from head to toe. Your feet are at particular risk for a number of reasons, and they are checked every year in your annual diabetes check-up at your surgery. This ensures that any problems are found early and addressed.
Diabetes affects the circulation in your lower legs and feet by reducing the blood supply. This makes you more prone to cuts and sores and delays the healing process. In the long term this can lead to infections, ulcers and even amputations if the condition cannot be reversed. Diabetes can also affect the nerves to the feet, meaning that you feel things less, so you may not notice a blister on your heel that then gets infected and turns into an ulcer. On top of this, bacteria, fungi and yeast causing thrush need something to feed on, and if you have high sugar levels circulating, this provides the ideal meal, so diabetes attracts infection. Sadly diabetic foot disease does carry a risk of amputation if it reaches an advanced stage. As many as 169 amputations happen every week in the UK as a result of diabetes.
Your appointment will most likely be with the practice nurse at your GP surgery. They will ask you to take off shoes and socks or tights and expose to the knee. They will carefully examine the skin for any skin breakdown or ulcers, and they will test the nerves by whether you feel their touch and they will test for the foot pulses. They will talk you through any findings after your foot check. They will grade your risk may be low, moderate, or high. Those with moderate or high risk will be referred to a foot specialist called a podiatrist for further checks. You will be given advice about how to look after your feet, signs to watch out for and how to reduce the chance of developing significant disease. This is one part of your annual diabetic check-up, which also includes eye screening, blood tests, blood pressure, weight and your own rating of how diabetes is affecting your quality of life.
Keep an eye out for signs of acute infection – redness, pain, pus – especially if you have an insect bite, open sores or cracks in the skin. Fungal infections could start as smelliness, flaking, itching, slightly red areas, and fungal toenail infection will give thickened crumbly yellow-ish nails - they can infect each other. Signs of a nerve problem are suggested by pain, numbness, tingling, burning, or you may notice a wound or blister that seems a bit numb rather than painful. Leg cramps, especially when walking, dry red flaky skin on the lower legs, or any colour change or swelling to the lower legs, ankles or feet may suggest a circulation problem. Changes to the colour or sensation of a toe will need urgent assessment. For any of these symptoms, you should contact your GP or specialist diabetic team, if you have one, to have an assessment of your legs. This might need urgent assessment, depending on how quickly the problem has developed.
Managing your foot health means moisturising your feet daily helps to maintain the skin barrier, preventing dryness and sores from developing. It’s really important to look after your toenails, as these can cut into the skin on other toes if they get long, and are prone to fungal infection, which can also affect the skin (tinea pedis). Opt for nail clippers to cut the top of your nails regularly and nail files if necessary at the sides. Avoid the use of anything that can damage the skin of your feet like sharp objects, corn plasters or blades. It is very important you wear well fitted comfortable shoes to prevent blisters and sores from developing on your feet, and it will also help you on your way to keeping active to combat diabetes. Feet are at risk from other problems, so to keep them in the best condition, this is the time to address other risk factors. Smoking is detrimental to so many of the body’s systems, but it particularly furs up blood vessels, risking a blockage to the feet. High blood pressure and high cholesterol have similar effects on blood vessels. Excess alcohol over a long period can affect the nerves to the feet, causing peripheral neuropathy. Finally, eczema can cause problems with the lower legs and feet, so make sure you keep this under control with heavy moisturisers and prescribed creams when needed. Finally, with beating any complications from diabetes, you are committing yourself to a lifetime of taking your prescribed medications, eating a healthy well-balanced diet, keeping obesity at bay and exercising regularly.